Organization
DAVID S. PETERSEN, M.D.S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID S PETERSEN M.D. (PRESIDENT)
(309) 764-9790
Entity
Organization
Contact information
Practice address
2121 1ST STREET A, MOLINE, IL 61265-7745
(309) 764-9790
(309) 764-9632
Mailing address
2121 1ST STREET A, MOLINE, IL 61265-7745
(309) 764-9790
(309) 764-9632
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036-055984
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036055984
—
IL
Enumeration date
02/09/2011
Last updated
02/09/2011
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